Claims Appeals & Grievances Expert

Molina Healthcare; Jacksonville (FL); Vor Ort; USD 22.000 - 44.000; Vollzeit

Zusammenfassung

Molina Healthcare is seeking a claims specialist to support appeals, disputes, and grievances. You will review member and provider inquiries, research claims and notices, and prepare responses in line with CMS and Molina guidelines.

The role emphasizes accuracy, timeliness, and professional communication. Ideal candidates have 2+ years in managed care claims/appeals, strong customer service and organizational skills, and proficiency with Microsoft Office applications.

Qualifikationen

• Two years or more in a managed care claims/appeals environment or equivalent experience.
• Strong customer service experience and ability to handle sensitive information.
• Effective written and verbal communication and strong organizational skills.
• Proficiency with standard office software and data systems used in claims processing.

Aufgaben

• Researches and resolves member, provider, and outside agency complaints and appeals.
• Reviews medical records and bills to determine appropriate appeal or denial outcomes.
• Ensures timeliness and compliance with CMS, state, and Molina guidelines.
• Communicates resolutions to members, providers, or authorized representatives in writing and verbally.

Tools

Microsoft Office

Jobbeschreibung

Molina Healthcare is seeking a claims specialist to support appeals, disputes, and grievances. You will review member and provider inquiries, research claims and notices, and prepare responses in line with CMS and Molina guidelines.

The role emphasizes accuracy, timeliness, and professional communication. Ideal candidates have 2+ years in managed care claims/appeals, strong customer service and organizational skills, and proficiency with Microsoft Office applications.